Hepatitis C virus (HCV) infection is the most common blood-borne viral infection in haemodialysis. It causes significant morbidity and long-term mortality. Practice of universal precautions has been reported to be sufficient to prevent HCV seroconversion in dialysis units. However, the seroconversion rate remains very high in many dialysis units. A previous study from 1995 to 1998 at our own hospital without isolation showed that nosocomial transmission is the major cause of HCV seroconversion. The present study was therefore conducted with the aim to study the impact of isolation on HCV seroconversion. In this prospective cohort study, with non-probability consecutive sampling, patients with HCV infection were dialysed in an isolated room. In addition, standard universal precautions were practiced. HCV seroconversion rate was compared with the previous study. All patients with end-stage kidney disease (ESKD) admitted to our hospital for renal replacement therapy were included in the present study. At the time of admission, HCV screening was done. All anti-HCV-positive patients were dialysed in an isolated room. While on maintenance haemodialysis, all patients were monthly tested for anti-HCV, aspartate aminotransferase and alanine aminotransferase. Any patient who had HCV seroconversion was transferred to an isolated room for maintenance haemodialysis. Patients with HCV infection were managed by further testing for HCV-RNA and liver biopsy. Every patient who ultimately received renal transplantation at our hospital was also tested for HCV just prior to renal transplantation as well as 3 months after renal transplantation. HCV infection was diagnosed by detecting anti-HCV antibodies using an ELISA-based third-generation diagnostic test kit. Serum bilirubin, aspartate aminotransferase and alanine aminotransferase were assayed using standard laboratory techniques. From March 2003 to February 2006, 1,417 patients were admitted for haemodialysis in our unit. Of these 1,077 (76%) had ESKD. Mean age of patients was 42.47 ± 16.2 (14–94) and 70.39% were males. Patients with ESKD had had more dialysis sessions (10.9 ± 39.5 vs. 4.4 ± 5.95, p = 0.009), more blood transfusions and more pre-existing HCV infections (4.72 vs. 1.5%, p = 0.009) than patients with acute renal failure. Of the ESKD patients, 65.7% were discharged, 9.47% died, 1.85% were shifted to chronic ambulatory peritoneal dialysis and 22.46% patients received renal transplantation. Of the patients who received renal transplantation, HCV seroconversion was detected in 2.75%. In the previous study without isolation practices, the HCV seroconversion rate in transplanted patients was 36.2%. The hazard of HCV seroconversion was 0.97 (95% CI 0.93–1.02, p = 0.2) for each additional dialysis and 1.09 (95% CI 0.88–1.36, p = 0.37) for each additional blood transfusion. The study concludes that isolation of HCV-infected patients during haemodialysis significantly decreases the HCV seroconversion rate.

Keywords:
HCV, Haemodialysis, Isolation
1.
Sumathy S, Valliammai T, Thiyagrajan SP, Malathy S, Madangopalan N, Sankaranaraynan V, et al: Prevalence of hepatitis C virus infection in liver disease, renal disease and voluntary blood donors in South India. Ind J Med Microbiol 1993;11:291–297.
2.
Arankale VA, Chadha MS, Jha J, Amrapurkar DN, Banerjee K: Prevalence of anti HCV antibodies in Western India. Ind J Med Res 1995;101:91–93.
3.
Jaiswal SPB, Chitnis DS, Naik G, Artwan KK, Pundit CS, Salgia P, Sepaha A: Prevalence of anti HCV antibodies in central India. Ind J Med Res 1996;104:177–181.
4.
Salunkhe PN, Naik SR, Semual SN, Naik S, Kher V: Prevalence of antibodies to hepatitis C virus in HBsAg-negative haemodialysis patients. Ind J Gastroenterol 1992;111:164–165.
5.
Agarwal SK, Dash SC, Irshad M: Hepatitis C infection during haemodialysis in India. J Assoc Physicians India 1999;47:1139–1143.
6.
Pereira BJ, Levey AS: Hepatitis C virus infection in dialysis and renal transplantation. Kidney Int 1997;51:981–999.
7.
Le Pogam S, Le Chapois D, Christen R, Dubois F, Barin F, Goudeau A: Hepatitis C in a haemodialysis unit: molecular evidence for nosocomial transmission. J Clin Microbiol 1998:36:3040–3043.
8.
Jadoul M, Poignet JL: Prevention of hepatitis C virus transmission in haemodialysis. Néphrologie 1997;18:307–308.
9.
Dos Santos JP, Loureiro A, Cendoroglo Neto M, Pereira BJ: Impact of dialysis room and reuse strategies on the incidence of hepatitis C virus infection in haemodialysis units. Nephrol Dial Transplant 1996;11:2017–2022.
10.
Natov SN, Pereira BJ: Hepatitis C in dialysis patients. Adv Ren Replace Ther 1996;3:275–283.
11.
Jadoul M: Transmission routes of HCV infection in dialysis. Nephrol Dial Transplant 1996;11(suppl 4):36–38.
12.
Beccari M, Romagnoni M, Rizzolo L, Veneroni G, Sorgato G: Is isolation needed for anti-HCV-positive haemodialysis patients? Nephron 1996;72:372.
13.
Beccari M: Isolation for anti-HCV-positive haemodialysis patients? Ren Fail 1995;17:775–776.
14.
al Meshari K, al Ahdal M, Alfurayh O, Ali A, De Vol E, Kessie G: New insights into hepatitis C virus infection of haemodialysis patients: the implications. Am J Kidney Dis 1995;25:572–578.
15.
Fujiyama S, Kawano S, Sato S, Shimada H, Matsushita K, Ikezaki N, Nakano T, Sato T: Changes in prevalence of anti-HCV antibodies associated with preventive measures among haemodialysis patients and dialysis staff. Hepatogastroenterology 1995;42:162–165.
16.
Loureiro A, Macedo G, Pinto T: Hepatitis C virus infection in haemodialysis patients: lessons from epidemiology and prophylaxis. Nephrol Dial Transplant 1995;10(suppl 6): 83–87.
17.
Huraib S, al-Rashed R, Aldrees A, Aljefry M, Arif M, al-Faleh FA: High prevalence of and risk factors for hepatitis C in haemodialysis patients in Saudi Arabia: a need for new dialysis strategies. Nephrol Dial Transplant 1995;10:470–474.
18.
Agarwal SK, Dash SC, Mehta SN, Gupta S, Bhowmik D, Tiwari SC, Guleria S: Results of renal transplantation on conventional immunosuppression in second decade in India: a single-centre experience. J Assoc Physicians India 2001;50:532–536.
19.
Agarwal SK, Dash SC, Irshad M, Gupta S, Bhwomik D, Tiwari SC, Guleria S, Mehta SN: Impact of hepatitis C viral infection on renal transplant outcome in India: a Single center study. J Assoc Physicians India 2000;48:1155–1159.
20.
Agarwal SK, Irshad M, Dash SC: HCV Infection during renal replacement therapy: Should we dialyze all hepatitis-C-positive patients on dedicated machines? Nephron 1998;79:479–480.
21.
Agarwal SK, Mohan MP, Varghese M: Assessment of awareness regarding universal precaution among the nursing staff of AIIMS in 1997. J Assoc Physicians India 1998;46:1061.
22.
Lemeshow S, Hosmer DW Jr, Klar J, Lwanga SK (eds): Adequacy of Sample Size in Health Studies, ed 1. New York, Wiley, 1991, chapter The Incidence Rate, pp 29–35.
23.
Vikrant S, Agarwal SK, Gupta S, Bhowmik D, Tiwari SC, Dash SC, Guleria S, Mehta SN: Prospective randomised control trial of isoniazid chemoprophylaxis during renal replacement therapy. Transplant Infect Dis 2005;7:99–108.
24.
Fabrizi F, Poordad FF, Martin P: Hepatitis C infection and the patient with end-stage renal disease. Hepatology 2002;36:3–10.
25.
Dussol B, Berthezene P, Brunet P, et al: Hepatitis C virus infection among chronic dialysis patients in the south of France: a collaborative study. Am J Kidney Dis 1995;25:399–404.
26.
Hardy NM, Sandroni S, Danielson S, et al: Antibody to hepatitis C virus increases with time on hemodialysis. Clin Nephrol 1992;38:44–48.
27.
Seme K, Poljak M, Zuzec-Resek S, et al: Molecular evidence for nosocomial spread of two different hepatitis C virus strains in one hemodialysis unit. Nephron 1997;77:273–278.
28.
Stuyver L, Claeys H, Wyseur A, et al: Hepatitis C virus in a hemodialysis unit: molecular evidence for nosocomial transmission. Kidney Int 1996;49:889–895.
29.
Centers for Disease Control and Prevention: Recommendations for preventing transmission of infection among chronic hemodialysis patients. MMWR Recommend Rep 2001;50:1–43.
30.
Preventing HCV transmission in hemodialysis units. Kidney Int 2008;73(suppl 109):S46–S52; DOI: 10.1038/ki.2008.86.
31.
Khaja MN, Madhavi C, Thippavazzula R, Nafeesa F, Habib AM, Habibullah CM, Guntaka RV: High prevalence of hepatitis C virus infection and genotype distribution among general population, blood donors and risk groups. Infect Genet Evol 2006;6:198–204.
32.
Reddy AK, Murthy KV, Lakshmi V: Prevalence of HCV infection in patients on haemodialysis: survey by antibody and core antigen detection. Indian J Med Microbiol 2005;23:106–110.
33.
Chandra M, Khaja MN, Hussain MM, Poduri CD, Farees N, Habeeb MA, Krishnan S, Ramareddy GV, Habibullah CM: Prevalence of hepatitis B and hepatitis C viral infections in Indian patients with chronic renal failure. Intervirology 2004;47:374–376.
34.
Blumberg A, Zehnder C, Burckhardt JJ: Prevention of hepatitis C infection in haemodialysis units: a prospective study. Nephrol Dial Transplant 1995;10:230–233.
35.
Djordjevic V, Stojanovic K, Stojanovic M, et al: Prevention of nosocomial transmission of hepatitis C infection in a hemodialysis unit: a prospective study. Int J Artif Organs 2000;23:181–188.
36.
Taskapan H, Oymak O, Dogukan A, et al: Patient to patient transmission of hepatitis C virus in hemodialysis units. Clin Nephrol 2001;55:477–481.
37.
Harmankaya O, Cetin B, Obek A, Seber E: Low prevalence of hepatitis C virus infection in hemodialysis units: effect of isolation? Ren Fail 2002;24:639–644.
38.
Saxena AK, Panhotra BR, Sundaram DS, Naguib M, Venkateshappa CK, Uzzaman W, Mulhim KA: Impact of dedicated space, dialysis equipment, and nursing staff on the transmission of hepatitis C virus in a hemodialysis unit of the Middle East. Am J Infect Control 2003;31:26–33.
39.
Yang CS, Chang HH, Chou CC, Peng SJ: Isolation effectively prevents the transmission of hepatitis C virus in the hemodialysis unit. J Formos Med Assoc 2003;102:79–85.
40.
Gallego E, López A, Pérez J, Llamas F, Lorenzo I, López E, Illescas ML, Andrés E, Olivas E, Gómez-Roldan C: Effect of isolation measures on the incidence and prevalence of hepatitis C virus infection in hemodialysis. Nephron Clin Pract 2006;104:c1–c6.
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